Cubilla A L, Velazques E F, Reuter V E, Oliva E, Mihm M C, Young R H
Instituto de Patologia e Investigacion and Facultad de Ciencias Medicas, Asuncion, Paraguay.
Am J Surg Pathol. 2000 Apr;24(4):505-12. doi: 10.1097/00000478-200004000-00004.
Within the spectrum of penile squamous cell carcinomas, those that we descriptively refer to collectively as the "verruciform" lesions are particularly difficult to subclassify. In a review of 50 such tumors, we found 11 distinctive neoplasms with condylomatous features conforming to the appearance of so-called "warty (condylomatous) carcinoma." The average patient age was 55 years and the average duration of disease was 19 months. The primary tumor involved multiple anatomic sites (glans, coronal sulcus, and foreskin) in seven cases and a single site (glans or foreskin) in four cases. Grossly, white to gray cauliflower-like tumors typically measuring approximately 5 cm were noted. Histologically the tumors were mainly papillomatous with acanthosis and hyperkeratosis. The papillae had prominent fibrovascular cores. The most conspicuous microscopic findings were striking nuclear atypia of koilocytotic type and clear cytoplasm. The interface between tumor and stroma was irregular in the majority of cases; deep invasion of corpus cavernosum was noted in five cases. The differential diagnosis included verrucous carcinoma, low-grade papillary squamous cell carcinoma, not otherwise specified, and giant condyloma acuminatum. Among other differences, the first two lesions show no koilocytotic changes and the last lacks malignant features and irregular stromal invasion. Metastatic spread occurred in two patients; both are alive with evidence of recurrent disease 12 and 72 months after initial diagnosis. A third patient was alive with recurrent disease 12 months after diagnosis. Five patients were free of disease 8, 12, 24, 52, and 108 months after diagnosis. Three patients were lost to follow up. Warty (condylomatous) carcinomas of the penis are morphologically distinctive verruciform neoplasms with features of human papillomavirus-related lesions and should be distinguished from other verruciform tumors so that differences in behavior, if any, between these tumors will become established.
在阴茎鳞状细胞癌的范畴内，那些我们统称为“疣状”病变的肿瘤尤其难以进行亚分类。在对50例此类肿瘤的回顾性研究中，我们发现了11种具有湿疣样特征的独特肿瘤，其外观符合所谓的“疣状（湿疣样）癌”。患者的平均年龄为55岁，疾病的平均病程为19个月。原发性肿瘤累及多个解剖部位（龟头、冠状沟和包皮）的有7例，累及单个部位（龟头或包皮）的有4例。大体上，可见白色至灰色的菜花状肿瘤，通常直径约为5 cm。组织学上，肿瘤主要为乳头状，伴有棘层增厚和角化过度。乳头具有明显的纤维血管轴心。最显著的显微镜下表现是凹空细胞型的明显核异型性和透明的细胞质。在大多数病例中，肿瘤与间质的界面不规则；5例可见海绵体深层浸润。鉴别诊断包括疣状癌、未另行特指的低级别乳头状鳞状细胞癌和巨大尖锐湿疣。在其他差异方面，前两种病变无凹空细胞改变，而最后一种缺乏恶性特征和不规则的间质浸润。有2例发生了转移；两名患者在初次诊断后12个月和72个月仍存活，有复发疾病的证据。第三名患者在诊断后12个月因复发疾病存活。5例患者在诊断后8、12、24、52和108个月无疾病。3例患者失访。阴茎疣状（湿疣样）癌是形态学上独特的疣状肿瘤，具有人乳头瘤病毒相关病变的特征，应与其他疣状肿瘤相鉴别，以便确定这些肿瘤之间行为上的差异（如果有的话）。
